By Maryam Pariseai
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Extra resources for Obstetrics and Gynaecology
This is inaccurate and can lead to inappropriate treatment because many incontinent women will admit to both symptoms, although in only 5% of women will SUI and DO coexist. ‘The bladder is an unreliable witness’ is an old adage and suggests that presenting symptoms do not correlate well with the underlying bladder condition. For example, a patient giving a history of stress incontinence may have detrusor overactivity as the underlying pathology. Stress urinary incontinence The most common symptom of SUI is stress incontinence, usually small amounts of urinary leakage.
Amenorrhoea is often preceded by many years of oestrogendependent symptoms. From a biological viewpoint it is unlikely that the ovaries are suddenly switched off; their function is more likely to decline gradually, with the cessation of periods as an endpoint that is reflected by the occurrence of irregular periods, decreased fertility, increasing premenstrual syndrome and climacteric depression before the amenorrhoea of the menopause. This can result in difficulties in differential diagnosis, depending on which of the following menopausal symptoms predominate.
Ectopic pregnancy. The uterus is enlarged in pregnancy and the cervical os might be open if the patient is miscarrying. A fixed, tender, retroverted uterus could be a result of endometriosis or PID. The uterus typically feels tender and bulky with adenomyosis. Investigations of Patients Who have Pelvic Pain and Dyspareunia A summary list of the investigations used in patients who present with pelvic pain and dyspareunia is shown in Fig. 4. Fig. 5 is an algorithm for the diagnosis, investigation and treatment of pelvic pain.